title: Trimethoprim-sulfamethoxazole-associated severe hypoglycaemia: a sulfonylurea-like effect.
abstract: OBJECTIVE
  To report hypoglycaemia, a life-threatening adverse event, associated with trimethoprim-sulfamethoxazole. A sulfonylurea-like effect, leading to insulin raise, was investigated.
  
  
  METHODS
  Two cases of trimethoprim-sulfamethoxazole-associated hypoglycaemia in 2 patients with a diagnosis of new HIV-1-infection presenting with Pneumocystis jiroveci pneumonia are reported. The patients had no predisposing factors, such as renal or liver impairment, interfering with trimethoprim-sulfamethoxazole elimination, thus leading to hypoglycaemia. Insulin plasma levels were measured in both patients.
  
  
  RESULTS
  Severe hypoglycaemia was associated with increased serum levels of insulin up to 84 microU/ml (normal values < 10 microU/ml). Continuous dextrose infusion was necessary, further suggesting the sulfonylurea-like effect of sulfamethoxazole. Interestingly, plasma levels of insulin progressively raised after trimethoprim-sulfamethoxazole administration.
  
  
  CONCLUSIONS
  Only 18 cases of trimethoprim-sulfamethoxazole associated hypoglycaemia are reported in the literature. Hypoglycaemia is a life-threatening condition, likely underreported, to consider when trimethoprim-sulfamethoxazole administration is required, even in the absence of predisposing factors or other hypoglycaemic agents. Physician should bear in mind the potential trimethoprim-sulfamethoxazole-associated adverse event especially when prolonged treatments and elevated dosage are used.
authors.affiliation: Department of Medicine, Unit of Infectious Diseases, ARNAS Garibaldi, University of Catania, Catania, Italy. gnunnari@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Nunnari
authors.forename: B M
authors.initials: BM
authors.lastname: Celesia
authors.forename: F
authors.initials: F
authors.lastname: Bellissimo
authors.forename: S
authors.initials: S
authors.lastname: Tosto
authors.forename: M
authors.initials: M
authors.lastname: La Rocca
authors.forename: F
authors.initials: F
authors.lastname: Giarratana
authors.forename: F
authors.initials: F
authors.lastname: Benanti
authors.forename: E
authors.initials: E
authors.lastname: Caltabiano
authors.forename: R
authors.initials: R
authors.lastname: Russo
authors.forename: B
authors.initials: B
authors.lastname: Cacopardo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000187:drug effects*; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D007328:Insulin / Q000097:blood; D008297:Male; D045363:Pneumocystis carinii / Q000472:pathogenicity; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000382:microbiology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D001786:Blood Glucose; D007328:Insulin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D005947:Glucose